CBCT在下颌阻生第三磨牙拔除术前风险评估中的应用  

Study of Cone Beam CT in risk assessment and planning approach for extraction of impacted mandibular third molar

作　　者：黄兰柱[1] 王铁梅[2] 黄政[1] 盛璐[1] 刘澍[2] 

机构地区：[1]南京大学医学院附属口腔医院口腔颌面外科,江苏南京210008 [2]南京大学医学院附属口腔医院颌面影像科,江苏南京210008

出　　处：《临床口腔医学杂志》2014年第11期674-676,共3页Journal of Clinical Stomatology

基　　金：南京市医学科技发展专项资金资助课题(YKK12120)

摘　　要：目的:运用CBCT评估下颌阻生第三磨牙拔除术中下牙槽神经损伤的手术风险,并指导拔牙手术径路选择。方法:对曲面体层片显示下颌第三磨牙根端与下颌神经管接触重叠,评估下牙槽神经易损伤病例42例,65侧下颌阻生第三磨牙,进行CBCT检查。两组医师(每组口腔外科医师和颌面影像科医师各1名)分别根据曲面体层片和CBCT图像评估拔除下颌第三磨牙时下牙槽神经损伤的风险程度并进行手术设计,应用x2检验两种影像评测结果之间的差异度。结果:评估拔除下颌阻生第三磨牙时出现下牙槽神经损伤的可能性经曲面体层片和CBCT对比研究差异具有统计学意义(P<0.001)。与曲面体层片相比,CBCT为临床医师提供了阻生磨牙与下颌神经管之间三维影像的空间距离,有效辅助了牙拔除手术方式的设计(P<0.001)。结论:拔除下颌阻生第三磨牙可能造成下牙槽神经损伤的评估中,与曲面体层片相比,CBCT可以更好地评估手术风险,能指导术者帮助选择更恰当的术式。Objective：To investigate the risks of inferior alveolar nerve（IAN） injury by removing impacted mandibular third molar,and difference of the surgical techniques by cone beam CT（CBCT）. Method：Subjects with an increased risk of IAN injury,as diagnosed on panoramic radiographs,were enrolled in this study and underwent additional CBCT imaging. Two groups of doctors（each group contains a oralmaxillofacial surgeon and a radiologist） independently planned the surgical tech-nique and estimated the risk of IAN injury on panoramic radiographs and on CBCT images.A test of Chi-square test was exe-cuted to calculate the differences between the two imaging modalities. Result：The study sample comprised 42 patients（mean age 30.5 years） presenting 65 mandibular third molars. Risk assessment for IAN injury based on panoramic radiography compared with CBCT imaging differed significantly （P〈0.001）. After reviewing the CBCT images,the clinicians get the pre-cise distance and the relative relationship of the mandibular third molar and inferior alveolar canal compared with the panoramic radiograph assessments. This change in risk assessment also resulted in a significantly different surgical approach （P 〈0.001）. Conclusion： This study show that CBCT contributes to optimal risk assessment and,as a consequence,to more adequate surgical planning,compared with panoramic radiography.

关 键 词：CBCT 曲面体层摄影 阻生牙 下颌神经管 

分 类 号：R782.1[医药卫生—口腔医学]